Access Change Request

If you are human, leave this field blank.

Access Change Request

Do not use this form to request access changes to Paychex.

Date *

Requesting Manager's Name *

Email *

Phone *

Area Supervisor's Name *

Mall Name *

Location Number *

Reason for Access Request *

Select a Reason for Access Request to show available options.

New Hire / Rehire

Change of Status

Termination/Resignation

Other. Please specify in notes below.

Date Access Should Be Active/Deactivated *

For New Hire provide first scheduled day. For Termination provided employee's last day scheduled. For Change of Status or Other provide the day the new access should go into effect.

Name of Person Access Change Requested For *

Job Title *

Employee's Mobile Phone Number

Employee's Email Address *

Used for adding or removing from company communications including benefits.

Employee's Birth Date.

Only provide month and day.

Access Change Requested (check all that apply)

Infoplace Email Address

Gift Card Access

Kipsu Access

Passport to Shopping

Uniform and Name Tag Only. No other access required

Please send New Hire paperwork to corporate before completing this form. Email to Sherry@infoplaceusa.com. Note: You may be contacted to verify the need for certain access.

Access Removal Requested (check all that apply)

Infoplace Email Address Removal

Gift Card Access Removal

Kipsu Access Removal

Passport to Shopping Removal

Please send the P-1640 Termination/Resignation form to corporate as soon as possible. Email to Sherry@infoplaceusa.com.

If requesting gift card access change please check the system used at your location.

For CardSpot access only: New Hire's Mother's Maiden Name

Uniform Size / Notes

Name Tag Needed?

Yes

Please provide name as you would like it printed on name badge.

What is the reason for this access request?

Please provide details.